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Dr. Minocha  is a practicing gastroenterologist and author of "Natural Stomach Care: Treating and Preventing Digestive Disorders with Best of Eastern and Western Therapies"

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Esophageal perforation due to endoscopy is rare and depends on the type of endoscope and intervention used. Rigid endoscopes scopes have higher risk (0.1-1.9%) than the flexible endoscopes (0.007-0.15%).

  • Perforation due to endoscopy has mortality rate of 18-49% with medical management and 16-21% with surgical management. Intrathoracic perforations are at higher risk for mortality than cervical perforations.


  • Simple pneumomediastinum due to endoscopy may be difficult to distinguish from perforation. It may occur due to gagging, retching during the procedure.


  • Chest x ray may demonstrate sub-cutaneous emphysema, pneumothorax and pneumomediastinum. Contrast studies of esophagus should be done first using gastro-graffin. If this is negative, barium should be used. A negative study does not exclude perforation.


  • Patients with pneumothorax need chest tube placement. Management of esophageal perforation is usually surgical emergency since mortality increases with delayed surgery. On rare occasions, a self-contained leak in clinically stable patients without any evidence of infection may be managed medically. In latter case, the patient should be very carefully monitored and an low threshold for surgical intervention should be employed.


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MINOCHA A et al.:Pneumomediastinum As A Complication Of Upper Gastrointestinal Endoscopy. Journal of Emergency Medicine1991

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